Question
I’m still breastfeeding my first baby who just turned one. My menstruation has not resumed since pregnancy. As I’m planning for second baby now, how do I know my ovulation period? How do I maximize the chance to conceive?
Breastfeeding can provide up to 98% contraception if it meets three certain criteria.
Answer
Before I can advise on the possibility of getting pregnant while breastfeeding, we must understand how breastfeeding can influence the chance of subsequent pregnancy.
In 1988, a group of scientists met in Bellagio, Italy to define a set of guidelines that a woman could use to predict her return to fertility during breastfeeding. The scientists reviewed data from studies regarding return to fertility and determined that breastfeeding can provide up to 98% effective contraception if three criteria are met:
- The mother has not experienced the return of her menstrual period (bleeding up to the 56th postpartum day is considered part of the postpartum recovery process and is not counted as menstrual bleeding);
- The mother is fully or nearly fully breastfeeding; and
- The baby is less than six months old.
These guidelines later defined a new method of family planning called the Lactational Amenorrhea Method or LAM. Clinical trials have shown that LAM is at least as effective as the Bellagio scientists predicted it would be. Fewer than 1% of LAM users in three clinical trials became pregnant when all the three LAM criteria were met.
Of the three LAM criteria, the return of menstruation is the most important indicator of fertility. The studies conducted by Family Health International in Pakistan and the Philippines have shown that getting pregnant while breastfeeding is rare even beyond six months and the end of full breastfeeding among women who do not experience vaginal bleeding. Only 1.1% of the women in Pakistan and 2.6% of the women in the Philippines conceived during 12 months of lactational amenorrhea.
The pattern of breastfeeding exerts a strong effect on the resumption of menstruation and fertility. However, defining what is meant by “full” breastfeeding can be difficult. The following definitions are currently being used by family planning counselors who are teaching LAM:
- Full breastfeeding can be exclusive (no other liquid or solid is given to the infant) or almost exclusive (vitamins, water, juice or ritualistic feeds are given infrequently to the infant).
- Nearly full breastfeeding means that the vast majority of feeds (at least 85%) are breastfeeds. There can be some supplementation with another liquid or food, but supplementation never replaces or delays a breastfeed.
To find out how you can refrain from getting pregnant while breastfeeding, see the next page…
Until when is the LAM Method effective?
The Lactational Amenorrhea Method is, however, a temporary method of family planning. To continue effective pregnancy protection, a woman who uses LAM must be ready to switch to another family planning method when any one of the LAM criteria changes. She should be made aware that:
- Once her periods return, breastfeeding will no longer protect her from a new pregnancy. She should consider any vaginal bleeding (after the 56th postpartum day) to be a warning that her fertility is returning, even if that bleeding does not resemble her regular menses.
- If she starts to give the infant any food or drink on a regular basis or experiences disruptions in her breastfeeding routine, such as returning to work or ceasing to breastfeed at night, she is no longer protected from pregnancy.
- Once the infant is older than six months, the chance of becoming pregnant, even before her periods return, is increased.
If any of these changes occur, a woman should choose another contraceptive method if she wants to be protected from pregnancy. There is no need to discontinue breastfeeding, however.
Family planning methods that are recommended for breastfeeding women include barrier methods, IUDs, male or female sterilization, and hormonal methods that contain only progestin, such as progestin-only pills (“minipills”), injectables and Norplant. Contraceptive pills containing both estrogen and progestin (the most common kind of birth control pill) have been associated with reduced breastmilk production and should be considered a last-choice method.
If you are breastfeeding according to the Lactational Amenorrhea Method without the intention of contraception, then the other ways to determine your fertile period is to use your body’s physiological changes during your normal menstrual cycle.
Ovulation tends to occur just before a spike in body basal temperature. That is the temperature just before getting out of bed in the morning. This is due to the heat-producing hormone progesterone created by the corpus luteum. So to increase the chance of pregnancy, you and your partner should act as soon as you see the rise in temperature.
The other way is to observe your vaginal fluid. As you enter your fertile period, the cervical fluid becomes more gelatinous and transparent. This is to allow easier sperm mobility during this fertile period. For images on how a woman’s cervix and cervical fluid changes during the course of the normal menstrual period, look at beautifulcervix.com, especially at Day 17 and 19.
Answered by: Dr. Dana Elliott Srither, MBBS (S’pore), Grad Dip Family Medicine, is a certified Family Physician who believes in the principles of “Get Well” and “Stay Well”.
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